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Abstract: SA-PO732

Does Intraperitoneal Pressure Vary in Peritoneal Dialysis Patients According to the Moment of Measurement?

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Procaccini, Fabio, Hospital Clinico San Carlos - Madrid, Madrid, Spain
  • Shabaka, Amir, Hospital Clinico San Carlos - Madrid, Madrid, Spain
  • Tornero, Fernando, Hospital Clinico San Carlos - Madrid, Madrid, Spain
Background

Elevated intraperitoneal pressure (IPP) in peritoneal dialysis patients (PD) is linked to alterations in peritoneal transport.
IPP is commonly measured at the start of volume infusion and a maximum IPP of 18 mmHg has been recommended which corresponds to 1400ml/m2 of volume infusion.
Nevertheless, there may be an adaptation of the peritoneal cavity that could cause IPP to decrease during peritoneal dwell time. Our aim was to study the hypothesis of peritoneal cavity adaptation, and analyze the relationship between IPP and dialysis infusion and drainage volumes.

Methods

We determined IPP in 17 patients in the PD program at our center by measuring the fluid column of solution in the drainage tube at the beginning and end of the peritoneal equilibration test (PET). No patient presented peritonitis or abdominal complications within 4 weeks prior to measurement. Demographic, anthropometric and PET data were collected.

Results

Out of the 17 patients studied, 12 were men (70.6%); 12 were on CAPD (70.6%) and 5 on APD (29.4%), mean age 61.87±17.8 years, mean body mass index (BMI) was 29.01±5.48 kg/m2, mean body surface area was 1.82±0.23 m2, median time in PD was 499 days (IQR 142-880.5).
The mean IPP was 14.47±4.34 cmH2O after infusion and 15±4.64 cmH2O at drainage. Mean ultrafiltration was 516.12±269.5 mL with a mean weekly Kt/V of 2±0.45.
We observed a decrease in IPP/volume ratio of 7.97±3.68 cmH2O/mL (p= 0.019) at drainage compared to the initial infusion value.
IPP/intraperitoneal volume ratio (at both infusion and drainage) showed strong correlation with volume/BSA ratio (at infusion; r= -0.624, p= 0.007 and at drainage; r= -0.703, p= 0.002).
There was a significant correlation between infused volume/initial IPP and final IPP, so that the final IPP= 21.114 - [0.041x (Infused Volume/initial IPP)] (r= 0.578, p= 0.015). There was a correlation between final IPP/BSA and infusion volume so that Volume Infused= 2355.201 - [52.727 * (final IPP/BSA)] (r= 0.630, p = 0.007).

Conclusion

The lower IPP/volume ratio at drainage confirms the adaptation of the abdominal cavity during dwell time, rendering it more important to measure IPP at the end of the exchange. We have determined an equation to predict the final IPP at drainage by measuring IPP at infusion based on infusion volume and BSA. In addition, IPP showed stronger correlation to BSA than to weight.